4 Million Patients Every Year and Growing
The PearlDiver Patient Records Database shows that bunion is one of the most reported diagnoses in the area of feet and ankles. Bunions (ICD-9-D-727.1) are caused by a mechanical imbalance and undue stress on the big toe joint. The leaning of the big toe toward the second toe throws the bones of the foot out of alignment, causing a protuberance of bone or tissue around the joint. Orthopedists describe bunion deformities as a condition in which the big toe (hallux) deviates from the normal position toward the direction of the baby toe, referred to as hallux valgus. The bump that develops on the side of the big toe is the bunion.
Bunion diagnosis and surgery to correct it has increased every year. Dr. Eduardo M. Suero, an orthopedic surgeon at the Hospital for Special Surgery in New York, reported in an interview at the Orthopedic Device and Technology seminar in Fort Wayne, Indiana, that bunions are one of the most common diagnoses reported in his hospital. Bunions appear to have two causes—one genetic and the other social. A hereditary tendency for bunions is passed on to patients within their families, particularly from mothers to daughters. Bunions are also aggravated by the wearing of ill-fitting shoes—the social cause. While bunions may not be caused by shoes in general, ill-fitting shoes aggravate the inherited faulty foot mechanics that put abnormal stress on the front of the foot. A study by the American Orthopedic Foot & Ankle Society reported that 88% of women wear shoes that are too small and almost 55% of them have developed bunions.
PearlDiver data reveals that bunion holds one of the top ten diagnoses reported in the foot and ankle region. Chart 1 below illustrates the most reported diagnoses. Bunion accounted for almost 5% of all foot and ankle diagnoses reported between January 2004 and June 2007.
Chart 1: Top Foot and Ankle Diagnoses in PearlDiver Patient Record Database
Source: PearlDiver Patient Records Database 2004-2006
Chart 2 shows the yearly progression of patients experiencing a bunion diagnosis within our PearlDiver database. There has been a steady increase in bunion diagnoses since 2004. The number is projected to continue to rise as patients initially ignore their bunions or treat them temporarily by modifying their shoes for short-term relief. According to our database, females make up 81% of the patients who experience some sort of bunion deformity.
PearlDiver data is based on patients less than 65 years of age and does not include MEDPAR data. PearlDiver data shows that while a diagnosis of bunion can occur at any age, the majority (over 45%) occur to patients between the ages of 40 to 64 years. PearlDiver analysts estimate that the total number of patients affected by some sort of bunion deformity, including hallux valgus (735.0), in the U.S. is over four million. If one counts patients with mild bunions, the number is considerably higher.
Chart 2: Bunion Yearly Progression and Forecast 2004-1010E
Source: PearlDiver Patient Record Database 2004-first half of 2007 and PearlDiver Estimates.
Most patients, approximately 80%, opt for temporary relief. For minor problems, doctors recommend that patients wear wider shoes made of soft leather with adequate space between the toes. Other nonsurgical treatments include splints to reposition the big toe, orthotics—inserts which are shaped to fit the foot for pain relief, and medication to reduce pain and swelling. There are surgical options to treat bunions as well. These range from the repair of the tendons and ligaments around the big toe, to arthrodesis, exostectomy, and osteotomy and resection arthroplasty. About 99% of the surgery is performed in an outpatient setting.
Chart 3 illustrates the most common surgical procedures for treatment of bunion deformity including the charges. Correction of hallux valgus (bunion) with or without sesamoidectomy, with metatarsal osteotomy (CPT-28296) is the most-performed surgery within the database. The average charges for this procedure fall in the range of $1,700 to $2,700. Few patients underwent bunionectomy, which is a much more complicated procedure, requiring a hospital stay of 1 to 2 days and a cost to the patient of well over $20,000.
Chart 3: Mostly Performed Surgical Treatment for Bunions (2004-2006)
Source: PearlDiver Patient Record Database 2004-2006.
Despite the fact that over four million patients are reporting bunion problems annually, the orthopedic sector has paid little attention to the bunion market. Wright Medical is one of the leading companies providing surgical instruments for treatment of bunions. John T. Treace, Vice President of Biologics and Extremities, calls bunions Wright Medical’s “sweet spot.” Treace also mentions that nationally about 500,000 bunion procedures are treated surgically, which is a very staggering number.
Treace also mentions that Wright has a very solid share within the bunion market offering various options to surgeons and doctors including the multiple screws and plating options. According to Treace, Wright probably holds about 20%–30% of the reconstructive foot market and is broadly distributed over a number of procedures within the foot. Depuy, Tornier, and Integra LifeSciences are other players within the foot and ankle market that deals with bunions and hallux valgus treatment products.
While as many as 12 million women in the United States may be suffering from some sort of foot deformity, the bunion market, while growing, is still being treated mainly with non-operative treatments to give temporary relief. Bunion is one of those market that is never ending as the root cause itself is predominantly hereditary.